Last October, we informed you of the launch of the multi-country research project "Taking Results Based Financing from scheme to system”. We also expressed our desire to inform you regularly on the progress of this program and to share with you possible lessons, including on the process. The preparatory phase is coming to an end now. In the coming days, research teams from 11 countries will kick off their qualitative research with a major wave of interviews.
As a reminder
Launched by the Alliance for Health Policy and Systems Research (AHPSR) and funded by Norway, this research project aims to examine the experiences of eleven low- and middle-income countries to identify the characteristics and factors that allow (or don’t allow) RBF programs to move from pilot stage to full integration into national health systems. 
The first stage of this research project mainly comprised the development of research protocols of the eleven country projects and their validation by ethics review committees and in particular WHO’s ethics review committee.
The protocol development workshop
In order to launch the research project under the best auspices, a workshop was held at the Institute of Tropical Medicine (ITM) in Antwerp, from 20 to 24 October 2014. The aim of this meeting was to bring together lead researchers from different country teams to jointly work on the development of their research protocols and in particular on defining their research questions. In addition to the principal investigators of each country team, the scientific team of the ITM (led by Professor Bruno Meessen) and the team in charge of the project within the Alliance (Mrs. Maryam Bigdeli and Mr Zubin Shroff) attended the workshop. A representative of the World Bank (Mr Kent Ranson) and WHO (Mrs. Inke Mathauer) were also present.
The event worked out the way we wanted: as a platform for meaningful exchange that enabled everyone to relate his/her experience with the research issue to be tackled and to share his/her own reflection and analysis. The organization of a bilateral meeting also allowed the organizers to adjust to the expectations and needs of the various participants. This facilitated in turn a shared and collaborative dynamic to achieve the anticipated results. You can access the program of the workshop here.
One of the concerns of the scientific coordinators was to ensure the feasibility of the research (a mistake often made by researchers is that they are too ambitious in terms of the number of questions they want to answer). Consequently, it was decided that each country would have to focus on two research questions. The first one is common to all countries, and will involve describing the nature and process of scaling up RBF. The development of a timeline is one of the tools which will be used to describe the different dimensions of the RBF scaling up process. The second research question aims to be more analytical and varies from one country to another depending on the context and national issues.
Finally, the concept of ‘scaling up’ sparked quite some discussion. There is often this somewhat simplistic notion and wish to understand the process of scaling up in its geographical dimension (only). But other dimensions such as the number of services covered or the level of integration in the health system shouldn’t be overlooked either. We also hope to advance the state of knowledge in this respect.
Interviews at the country level are about to start
After the Antwerp workshop, a remote technical support system was set up to assist research teams. This technical support addresses two major challenges: maintaining a dynamic exchange and sharing process throughout the project; and support the teams in conducting their research.
One of the challenges of this research is the rather short time frame to carry it out, due to external constraints. The pressure was therefore high during the weeks following the workshop to finalize and review protocols. During this revision, particular emphasis was placed on the methodological approach - which will consist primarily of a document review and key informant interviews – and on the ethical considerations, including on a valid system to anonymize the interviews (at the workshop, we clearly identified the sometimes highly political nature of a reform like RBF).
More importantly, several tools were used to ensure smooth communication between support teams (ITM and AHPSR) and research teams after the workshop. For example, the creation of a shared Dropbox folder with research teams facilitated the sharing of key methodological documents related to: (i) the application of theoretical and analytical frameworks, when analyzing health policies, (ii) the methods and practices for in-depth interviews, (iii) the literature on the scaling up process of policies, and (iv) stakeholder analysis methods. We have also started using webinar technology.
Over the last days, country teams have received the reports of the WHO ethics review committee. The comments were minor and are currently being integrated. Several teams also received the report of their national ethics committee. This will allow researchers to begin their round of interviews very soon. So if you are active in one of the 11 countries studied (or have played an important role in one of these countries in the past), maybe the interviewers will soon come knocking at your door. We hope that you will give them a warm welcome. Your knowledge matters: it is by documenting and analyzing the experiences in your country that we can produce lessons for all.
1. The countries are: Armenia, Burundi, Cambodia, Cameroon, Chad, Kenya, Macedonia, Mozambique, Rwanda, Tanzania, Uganda.